Diagnosis and Management of Plasenta Previa Percreata: Case Report

Placenta percreata becomes more common in the recent years with the increase of cesarean section and other uterine interventions. Diagnosis during pregnancy is very important. Patients with correct management have lower rates of morbidity and mortality. In this case we describe the management of a patient with placenta percreta that was referred to our perinatology clinic

Evaluation of patients with fibrotic interstitial lung disease: Preliminary results from the Turk-UIP study

OBJECTIVE: Differential diagnosis of idiopathic pulmonary fibrosis (IPF) is important among fibrotic interstitial lung diseases (ILD). This study aimed to evaluate the rate of IPF in patients with fibrotic ILD and to determine the clinical-laboratory features of patients with and without IPF that would provide the differential diagnosis of IPF. MATERIAL AND METHODS: The study included the patients with the usual interstitial pneumonia (UIP) pattern or possible UIP pattern on thorax high-resolution computed tomography, and/or UIP pattern, probable UIP or possible UIP pattern at lung biopsy according to the 2011 ATS/ERSARS/ALAT guidelines. Demographics and clinical and radiological data of the patients were recorded. All data recorded by researchers was evaluated by radiology and the clinical decision board. RESULTS: A total of 336 patients (253 men, 83 women, age 65.8 +/- 9.0 years) were evaluated. Of the patients with sufficient data for diag-nosis (n=300), the diagnosis was IPF in 121 (40.3%), unclassified idiopathic interstitial pneumonia in 50 (16.7%), combined pulmonary fibrosis and emphysema (CPFE) in 40 (13.3%), and lung involvement of connective tissue disease (CTD) in 16 (5.3%). When 29 patients with definite IPF features were added to the patients with CPFE, the total number of IPF patients reached 150 (50%). Rate of male sex (p<0.001), smoking history (p<0.001), and the presence of clubbing (p=0.001) were significantly high in patients with IPE None of the women <50 years and none of the men <50 years of age without a smoking history were diagnosed with IPE Presence of at least 1 of the symptoms suggestive of CTD, erythrocyte sedimentation rate (ESR), and antinuclear antibody (FANA) positivity rates were significantly higher in the non-IPF group (p<0.001, p=0.029, p=0.009, respectively). CONCLUSION: The rate of IPF among patients with fibrotic ILD was 50%. In the differential diagnosis of IPF, sex, smoking habits, and the presence of clubbing are important. The presence of symptoms related to CTD, ESR elevation, and EANA positivity reduce the likelihood of IPF

Pregnancy outcomes in women with strictly controlled type 1 diabetes mellitus

Objective: To evaluate the pregnancy outcomes in mothers with controlled Type 1 diabetes mellitus (T1DM). Materials and Methods: Thirty seven pregnant patients with controlled T1DM were included in the study. Results: Twenty (54%) out of 37 patients had preterm delivery (<37 weeks of gestation). The type of delivery was induced vaginal delivery in 9 (24.3%) patients and cesarean section in 27 (72.9%) patients. Preeclampsia developed in 6 (16.2%) patients. Macrosomia was found in 9 (24%) patients. Two antenatal death occured. Conclusion: Even in the most favorable conditions, the pregnant patients with T1DM would have a great risk for preterm delivery and cesarean section, moderate risk for macrosomia, preeclampsia, and an undefined risk for antenatal death

Increased circulating concentrations of asymmetric dimethylarginine (ADMA) in white coat hypertension

Elevated plasma levels of the endogenous nitric oxide ( NO) synthase inhibitor asymmetric dimethylarginine ( ADMA) contribute to endothelial dysfunction and seem to be a predictor for cardiovascular mortality. Elevated ADMA plasma concentrations have been demonstrated in patients with hypertension. However, the plasma concentrations of ADMA in white coat hypertension (WCH) has not been previously studied. The aim of this study was to evaluate ADMA in WCH and compare with normotensive (NT) and hypertensive ( HT) patients. We also evaluated the relation between ADMA and NO in these three groups. For this purpose, 34 NT, 34 white coat hypertensive ( clinical hypertension and ambulatory daytime blood pressure <135/85mmHg) and 34 HT patients were recruited in this study. The subjects were matched for age, gender, body mass index (BMI) and the patients with smoking habit, dyslipidaemia and diabetes mellitus were excluded. The ADMA levels were determined by high performance liquid chromatography. Plasma ADMA levels were significantly higher in WCH group than in the NT group (3.21 +/- 0.49 mu mol/l vs 2.84 +/- 0.58 mu mol/ l, P = 0.046). It was significantly higher in the HT group than in the NTs (4.24 +/- 0.38 mu mol/l, P<0.001). There was also a significant difference between the HT and WCH groups (P<0.001). The WCH subjects had significantly higher levels of NO than the HTs (41.68 +/- 2.23 vs 32.18 +/- 2.68 mu mol/l; P<0.001) and significantly lower values than the NTs (48.24 +/- 4.29 mu mol/l; P<0.001). In WCH and HT group, there was a negative correlation between ADMA and NO ( r = - 0.515, P = 0.003 and r = - 0.389, P = 0.034, respectively). In NT subjects, there was no correlation between these two parameters ( r = - 0.287, P = 0.124). The correlation between ADMA and NO was stronger in WCH group than in HT group. Although NO levels in HT patients were lower than WCHs and ADMA levels were higher in HT patients than WCHs, the negative correlation of these two parameters were more pronounced in WCH group. Decreased NO and increased ADMA levels in WCH may indicate endothelial dysfunction. Our data indicate also that WCH represent an intermediate group between NT and HT when endothelial dysfunction is concerned

Diagnosis and Management of Plasenta Previa Percreata: Case Report

Plasenta perkreata, sezaryen ile doğum ve diğer uterin girişimlerdeki artış ile beraber olarak son yıllarda daha yaygın görülür hale gelmiştir. Gebelik esnasındaki doğru tanının çok büyük önemi vardır. Doğru yönetilen hastalarda morbidite ve mortalite oranları daha düşüktür. Bu olgu sunumunda perinatoloji kliniğimize yönlendirilen bir plasenta perkreata olgusunun yönetimini sunmaktayız.Placenta percreata becomes more common in the recent years with the increase of cesarean section and other uterine interventions. Diagnosis during pregnancy is very important. Patients with correct management have lower rates of morbidity and mortality. In this case we describe the management of a patient with placenta percreta that was referred to our perinatology clinic